All 2nd year distance paramedic students were invited to participate across the two rounds of the intervention ( N = 159). Ethics approval was obtained from the hosting institution to issue this invitation and conduct the related study. To recruit participants for the study, an invitation was sent out to students studying the paramedics skills course and a list of potential candidates was developed, including location details for each candidate and their mobile digital device ownership. In particular, it is important that the theoretical framework selected allow for the data collected to be fed back into the growing literature on mixed reality education and make a contribution to how further interaction can be structured in the future: it is in this way that the work transcends a single case study and becomes useful as a study to push forward work in the area as a whole. Given the breadth of different solutions to mixed reality education problems exposed in the literature, it is clear that a methodology needs to be selected that can a) allow an iterative approach of testing and refinement and b) progress the overarching theory and narrative on how mixed reality can be used effectively in the classroom. In addition to identifying the right technology to use for a mixed reality intervention, a particular challenge in developing mixed reality education solutions is that the intervention must be tested with stakeholders, including students, and must be cycled on iteratively to ensure that the best final design is developed to address student needs. The developed intervention was tested with students and refined through a repeat of the process, showing that a DBR process, supported by a model that puts ‘pedagogy before technology’, can produce over several iterations a much-improved simulation that results in a simulation that satisfies student pedagogical needs.

This combined model is used to analyse a classroom learning problem in paramedic health sciences with respect to student evidence, assisting the educational designer to identify a solution, and subsequently develop a technology-based mixed reality simulation via a mobile phone application and three-dimensional (3D) printed tools to provide an analogue approximation for an on-campus simulation experience. This paper describes the use of a design-based research (DBR) methodology, combined with a new model for putting ‘pedagogy before technology’ when approaching these types of education problems, to develop a mixed reality education solution.

However, this approach to simulation becomes difficult when students are studying at a distance, leading to the need to develop simulations that suit this pedagogical problem and the logistics of this intervention method.

In health sciences education, there is growing evidence that simulation improves learners’ safety, competence, and skills, especially when compared to traditional didactic methods or no simulation training.

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